In a healthy person, the pleural chest cavity is generally an airtight, airless environment. During normal respiration, the contraction of the diaphragm increases the volume of the cavity, which in turn decreases the pressure therein and causes the lungs to expand. Normally, air cannot enter or escape the pleural cavity.
Patients who have fluid or air in this cavity may be treated by inserting a chest tube into the pleural cavity to drain this fluid or air. The chest tube typically comprises a plastic tube having drainage holes at its tip and in a section of its sidewall and is inserted through an incision in the wall of the patient""s chest. Ordinarily, the tube is connected to a collection container for holding the drained fluids. When the cavity of a given patient has been drained and the underlying cause of the fluid buildup has been addressed, the chest tube must be removed from the patient. This is done conventionally by withdrawing the tube and suturing the incision closed. In some patients, most notably children, no suturing is done, and petroleum jelly is used to seal the opening around the chest tube during the withdrawal of the tube. A gauze dressing is then placed over the incision and secured to the skin. However, if an inspiration occurs while the tube is partially pulled or before the incision is sealed, air can enter the pleural cavity due to the negative pressure therein.
Pneumothorax, or the passage of air into the pleural cavity, is undesirable because it allows the chest cavity to lose pressurization and decreases the expansion capability of the lungs. Complications of pneumothorax can include the collapse of part or all of a lung caused by pressure from free air in the chest cavity between the two layers of the pleura, which are thin membranes that cover the lung. Further complications associated with pneumothorax include respiratory failure and lung infection. Hospitalization and treatment with special equipment following minor surgery may be necessary for patients who suffer from pneumothorax.
Pneumothorax risk while removing a chest tube from a patient may be minimized by limiting the amount of air that can enter the chest cavity during and after removal of the tube. Ordinarily, upon removal of the chest tube from the body, a doctor or technician will attempt to hold the opening into the chest closed with the hand while undertaking to suture or bandage the opening. In many cases, however, the dressing placed over the opening is not completely air impermeable, or the attendant may have difficulty holding the opening closed while suturing the opening. While the pressure leaks may be minimal, these procedures are cumbersome to undertake, and the relatively minor leaks may compromise pressurization within the chest cavity and cause the patient some distress while breathing. More seriously, dressings or sutures may become completely undone, thereby allowing the cavity to depressurize more rapidly. This would, of course, more severely affect the ability of the patient to respirate properly and complicate a pneumothorax condition.
In accordance with the present invention, a combination sheath and dressing device is provided for use in assisting in the removal of chest tubes from patients and the dressing of the tube incision in the chest. The device allows a chest tube to be removed without allowing air into the chest cavity during the removal process, and facilitates the healing of the chest incision after the tube is removed. The device preferably includes an air-impermeable base dressing which is placed over the opening into the chest cavity. The base is connected to a tubular housing for receiving a conventional chest tube. The housing, which is attached to the dressing via a flexible boot structure, is used to allow some movement of the chest tube within the housing while maintaining pressure in the chest cavity. The flexible boot allows the dressing to be closed without compromising the pleural airspace.
In one aspect of the invention, a sheath device comprises a substantially rigid elongated body adapted to receive a chest tube. The body includes a first end and a second end, flexible seal at the first end, and an airimpermeable flexible joint at the second end. A base having a first side and a second side is provided at the joint, wherein the first side is connected with the flexible joint and the second side includes an adhesive for securing the base to a patient""s chest. The base provides an air-impermeable connection between the flexible joint and a patient""s chest cavity.
In another aspect of the invention, a method of preventing pneumothorax in a patient having a chest tube removed is provided. The method includes the steps of attaching to the patient""s chest an airimpermeable sheath device having a body, a joint, and a base such that the flexible joint and the base are removable from the body, and removing the chest tube through the sheath device. After the chest tube is pulled out of the patient""s chest and before the chest tube is entirely removed from the sheath device, a portion of the device is sealed and separated, thereby leaving an air-impermeable dressing over the patient""s chest.
In still another aspect of the invention, a sheath device for use on a patient having a chest tube inserted into the patient""s chest cavity includes a substantially rigid, hollow, air-impermeable body configured to fit snugly around a chest tube. The body includes a first end and a second end, seal at the first end of the body, an air-impermeable flexible sealable joint at the second end of the body, and a base. The base includes a first side and a second side, and the first side is connected with the flexible joint. The second side includes an adhesive for securing the base to the patient""s chest, and the base provides an air-impermeable connection between the flexible joint and the patient""s chest cavity. The flexible joint and base together may form an air-impermeable dressing on the patient""s chest.
The present invention provides the foregoing and other features, and the advantages of the invention will become further apparent from the following detailed description of the presently preferred embodiments, read in conjunction with the accompanying drawings. The detailed description and drawings are merely illustrative of the invention and do not limit the scope of the invention, which is defined by the appended claims and equivalents thereof.